Management of the tinnitus patient.

Abstract

At the Otologic Medical Group, we see many patients complaining of tinnitus. Because tinnitus is a symptom the underlying cause and disease process must be identified and evaluated. Most patients complaining of tinnitus will not require special treatment. In this paper we discuss the treatment of patients who are severely disturbed by their tinnitus. We also discuss the effects of surgery on tinnitus. This surgical treatment includes stapedectomies, translabyrinthine eighth nerve sections and translabyrinthine removal of acoustic neuromas. In patients with tinnitus as a primary complaint, stapedectomy can be expected to improve the tinnitus in 50%. In patients undergoing translabyrinthine section of the vestibular nerve, 45% reported improvement and 55% reported the tinnitus to be the same or worse. Following translabyrinthine removal of acoustic tumors, 40% felt that their tinnitus was better, 50% said it was worse and only 10% felt it was the same preoperatively. When the patients' symptoms are severe, we have recommended biofeedback training, tinnitus maskers, and, when appropriate, hearing aids. Of 132 patients undergoing biofeedback training, 77% of the patients reported some degree of relief. No patients were worse. Our acceptance and utilization of the tinnitus maskers has not been as successful. Of 42 patients undergoing tinnitus masker evaluations, only 17% eventually purchased the maskers. We have found that patients with some degree of hearing loss benefit greatly from the use of hearing amplification.